Opioid Use and HIV/HCV Risk among Immigrant Youth from the Former Soviet Union Principal Investigator: Honoria Guarino Informed by social ecological models of the risk environment, this exploratory study uses a mixed-methods approach to gain a multi-faceted, ethnographically-informed understanding of contextual factors shaping drug use, HIV/HCV risk, and utilization of drug treatment and HIV/HCV testing and prevention services among opioid-using young adult immigrants from the former Soviet Union (FSU). FSU immigrants are an increasingly significant group throughout the U.S. (nearly 1 million). Recent empirical and clinical evidence strongly suggests that opioid misuse and injection drug use (IDU) occur at alarmingly high rates among youth within FSU communities in the U.S., yet virtually no systematic research has been conducted on this problem. Moreover, due to a combination of sociocultural, behavioral and epidemiological factors unique to this population - including high-risk drug use environments in their countries of origin and, within their post- immigration communities, high rates of risky injection practices and sex work among young drug users and high background HCV prevalence - opioid-using FSU youth may be at heightened risk for HIV/HCV infection. These sources of vulnerability are compounded by a constellation of cultural factors specific to FSU immigrants, such as discomfort with traditional psychosocial drug treatment models predicated on self- revelation and a fear of community stigmatization, which have been reported to function as barriers to youths' use of drug treatment and disease prevention services. The proposed study will recruit a sample of 80 opioid- using FSU immigrants (ages 18-29) from the NYC area, 40 of whom will be in drug treatment, and 40 of whom will be current opioid users not in drug treatment. To allow us to characterize this understudied group, document their sex- and drug-related risk behaviors and drug use patterns, and explore the potential influence of immigration and acculturation on drug use and disease risk, these 80 youth will complete a series of structured assessments. Using theoretical sampling, a diverse subset of 24 youth will also be asked to participate in in-depth, qualitative interviews. In order to ensure that the research reflects the needs and perspectives of three key groups of FSU community stakeholders, we will also conduct: interviews with 6 experts with specialized knowledge of FSU youth drug use; focus groups with 12 drug treatment providers at facilities with substantial numbers of FSU clients; and interviews with 12 parents of opioid-using FSU youth. The proposed research promises to contribute significantly to public health by providing an evidence base to inform the development of culturally-targeted drug treatment approaches for the at-risk and underserved population of opioid-using FSU youth, as well as a culturally-appropriate HIV/HCV prevention intervention, to be developed in a subsequent proposal, that will be effective, acceptable, and engaging to this vulnerable group. Such empirically-grounded intervention efforts may help prevent localized outbreaks of HIV/HCV from occurring in FSU communities in the U.S. as have occurred in many former Soviet countries.